Provider Demographics
NPI:1053882951
Name:HENRY, INNA
Entity type:Individual
Prefix:
First Name:INNA
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6257 ANNEY LN
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-7154
Mailing Address - Country:US
Mailing Address - Phone:818-427-5554
Mailing Address - Fax:
Practice Address - Street 1:11650 RIVERSIDE DR STE 2A
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91602-1066
Practice Address - Country:US
Practice Address - Phone:818-427-5554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN